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. CERTIFICATE OF INSURANCE1L86 ISSUEDATE(MWONYY) <br /> M 11-23-93 <br /> PRODUCER THIS CEITIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS <br /> K Sc. K INSURANCE AGENCY, INC. NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND, <br /> EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> 1712 MAGNAVOX WAY <br /> P.O. BOX 2338 COMPANIES AFFORDING COVERAGE <br /> FORT WAYNE, IN 46801 <br /> COMPANY A <br /> INSURED LETTERTRANSAMFRT <br /> TTT'T^ r STATES A':•dAT+,TjR 7:'0X1 71-, IT. LETTER <br /> B <br /> TTPpER MI1 TEST GOLDEN GLOVES <br /> err 7 _ PIA711.h COMPANY C <br /> 0 OL SIC p1.A LETTER <br /> COLORAPO SPRINGS, CO. s 0909 <br /> COMPANY D <br /> . LETTER <br /> COVERAGES <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> • •• • ,• _a•is 6 •_ a _ _ __.. . ..• -_VF BEEN REDUCED BY PAID CLAIMS. <br /> COPOLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION ALL LIMITS IN THOUSANDS <br /> • LTR TYPEOFINSURANCE DATE(MW00/YY) DATE(MWDO/YY) <br /> GENERAL LIABILITY GENERAL AGGREGATE S IYnIVL <br /> X COMMERCIAL GENERAL LIABILITY SSP1340346 12:001 AM 12:00 PM PRODUCTS-COMP/OPS AGGREGATE S 1000 <br /> A CLAIMS MADE X OCCUR. 1-15 1-26-94 PERSONAL&ADVERTISING INJURY $1000 y©VOD <br /> OWNER'S&CONTRACTOR'S PROT. EACH OCCURRENCE s1000 <br /> ( FIRE DAMAGE(Any on.Bre) $ <br /> 5Q <br /> MEDICAL EXPENSE(Any on.porn) S 5 <br /> PARTICIPANT LEGAL LIABILITY • S 1000 <br /> AUTOMOBILE LIABILITY COMBINED <br /> SINGLE S <br /> ANY AUTO - LIMIT <br /> ALL OWNED AUTOS BODILY <br /> . INJURY $ <br /> •SCHEDULED AI IT^^ (Pet person) <br /> HIRED AUTOS BODILYINJURY S <br /> NON-OWNED AUTOS (Per accident) <br /> GARAGE LIABILITY PROPERTY S <br /> DAMAGE • <br /> EACH AGGREGATE <br /> EXCESS LIABILITY OCCURRENCE <br /> S S <br /> OTHER THAN UMBRELLA FORM STATUTORY •. <br /> WORKER'S COMPENSATION S (EACH ACCIDENT) <br /> AND <br /> _ _ _. ._. .. S (DISEASE—PCLIC(LIMIT) - <br /> EMPLOYERS'LIABILITY S I (DISEASE—EACH EMPLOYEE) <br /> AO&O S <br /> PARTICIPANT PRIMARY MtOICAL 1 <br /> ACCIDENTEXCESS MEDICAL S <br /> WEEKLY INDEMNITY S X <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS • <br /> EVENT: AMATEUR BOXING SHOW <br /> LOCATION: BEL RAE BALLROOM ' 5394 EDGEWOOD DRIVE MOUNDS VIEW, MN 55112 <br /> • CERTIFICATE HOLDER CANCELLATION <br /> • SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br /> • <br /> • EXNATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL <br /> U.S. AMATEUR BOXING FEDERATION -I�OAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br /> • 2 2316 31 ITR MIDWEST GOLDEN GLOVES BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY <br /> 113th• AVE '�1W. <br /> • COON RAPIDS, I�I. 5 533 OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. 1 <br /> AUTHORIZED REPRESENTATIVEVr{ <br /> - . "--- 01'1 f• <br /> '1/: <br /> { <br /> 6 FORM r SL•39 I I.. - <br />